"The purpose of this paper is to review Hwa-Byung, a cultural syndrome specific to Koreans and Korean immigrants. Hwa-Byung is a unique diagnosis and differs from other DSM disorders. However, Hwa-Byung has frequent comorbidity with other DSM disorders such as anger disorders, generalized anxiety disorder, and major depressive disorder. There are several risk factors for Hwa-Byung including psychosocial stress caused by marital conflicts and conflicts with their in-laws. Previous interventions of the Hwa-Byung syndrome were based primarily on the medical model. Therefore, based on previous research, we present a new ecological model of Hwa-Byung. We also recommend some areas of future research as well as present some limitations of our ecological model. Finally, we discuss some treatment issues, particularly for Korean women in the United States."

Importance of Studying Hwa-Byung

"Korean immigration to the United States has sharply increased over time. The national figure is approximately 1.7 million people, making Koreans one of the largest Asian groups in the US (Census Bureau, 2010). The rapid growth of the Korean population in the United States underscores the need to consider their mental health needs and the sociocultural factors that engender them. In spite of the growing mental health needs among this community, Koreans in America (both American-born and immigrants), tend to underutilize mental health services, and particularly those individuals with Hwa-Byung (Kim, Lee, Chu., & Cho, 1989). There are several reasons why Koreans in America who suffer from Hwa-Byung may not utilize mental health services for their benefit. Although Hwa-Byung patients are aware that their illness has psychogenic origins, these patients are unlikely to seek treatment by a psychiatrist or psychologist (Park, Kim, Kang, & Kim, 2001). Hwa-Byung patients are more attuned to their physical symptoms (which are socially acceptable), rather than their psychological symptoms (which are not). Thus, when they suffer from psychological distress, they are more likely to seek help from traditional medicine (herbal medicine) doctors, Chinese medicine doctors (e.g., acupuncturist), and shamans (Park et al, 2001) or rely on various drugs that manage their physical symptoms (Rhi, 2004). Koreans and Korean Americans also attempt to deal with their problems by relying on informal support from their family or close friends rather than seeking professional help from mental health services. Talking to mental health professionals about psychological problems may be viewed by Korean or Korean Americans as bringing disgrace to the family (Park et al., 2001). This cultural belief may lead Koreans or Korean Americans to seek mental health services as their last resort. Lastly, Koreans or Korean Americans underutilize mental health services because they are socialized to internalize stress and repress feelings. In addition, they may be socialized to believe that psychological problems are the result of a character flaw with negative mental associations and a lack of willpower which are shameful; therefore they must resolve the problems on their own (Lee, 1997)."